1. EXPOSURES TO AVOID IN PREGNANCY
PATRICK DUFF, M.D.

2. POWER OF THE M.D.

3. POTENTIAL FOR HARM
Thalidomide
Topiramate
Valproic acid

4. MECHANISMS OF PLACENTAL TRANSFER
Simple diffusion
Facilitated diffusion
Active transport
Pinocytosis

5. POSSIBLE TERATOGENIC EFFECTS
Anatomic abnormality
Impaired growth

6. TYPES OF TERATOGENS Medications Thalidomide Environmental agents
Irradiation
Heat
Chemicals
Smoking
Microorganisms
Maternal diabetes

7. TRIMESTER OF GREATEST FETAL VULNERABILITY

8. MOST LIKELY ORGAN SYSTEMS AFFECTED

9. ANIMAL MODELS TO ASSESS TERATOGENECITY

10. ORIGINAL FDA CLASSIFICATION OF DRUGS IN PREGNANCY
EXPLANATION A
No harm B
No harm but limited human studies C
Animal studies suggest risk D
Harmful X
Absolutely contraindicated
Discontinued in the summer of 2015

11. ACE INHIBITORS AND ARBs
Most likely adverse fetal effect?
Is the effect reversible?
Is there a safe period in pregnancy to use these drugs?

12. BETA BLOCKERS
Usual indications?
Adverse fetal effects?

13. CARBEMAZEPINE Possible indications in the mother?
Most likely harmful effects in the baby?

14. COUMADIN Most likely adverse effect in the fetus?
Alternative agents for anticoagulation in pregnancy?

15. DOLUTEGRAVIR What is the usual indication for use of this drug?
What is the mechanism of action of this drug?
What is the newly described fetal anomaly associated with use of this drug in early pregnancy?

16. HEAT How does the fetus dissipate heat? Critical time of exposure?
Most likely adverse fetal effect?

17. ISOTRETINOIN Most likely prescriber? Indication?
Adverse fetal effects?

18. LITHIUM Usual indication in the mother?
Most likely harmful effect in the fetus?

19. METHAMPHETAMINE Most likely adverse fetal effect?
Most likely adverse neonatal effect?
Effect on breast feeding?

20. NARCOTICS Two most likely sources of exposure?
Most likely adverse fetal effects?
Most likely adverse neonatal effect?

21. NSAIDS Usual indications? Adverse maternal effects?
Adverse fetal effects?

22. PHENYTOIN
Usual indication?
Most likely adverse fetal effects?

23. QUINOLONES Usual indications? Most likely harmful effect in the fetus?
Acceptable indications in pregnancy?

24. RADIATION
Dose threshold?
Most likely adverse fetal effect?

25. SSRIs Usual indication? Most dangerous of the SSRIs in pregnancy?
Most likely adverse fetal effect?

26. TETRACYCLINE/DOXYCYCLINE
Possible harmful effect in the mother?
Most likely adverse effect in the fetus?

27. THALIDOMIDE
Original indication?
Adverse fetal effects?

28. TOBACCO Most likely adverse fetal effects?
Most serious maternal complication?

29. TOPIRAMATE
Possible indications?
Newly described adverse fetal effect?

30. TRIMETHOPRIM-SULFAMETHOXAZOLE
Most likely adverse fetal effect with first trimester exposure?
Potential neonatal effect with exposure just prior to delivery?

31. VALPROIC ACID
Usual indications?
Most likely adverse fetal effect?

32. ZIDOVUDINE
Most common indication ?
Most likely adverse fetal effect ?

33. MICROORGANISMS
MICROBE
TERATOGENIC EFFECTS
Rubella
Varicella
CMV

34. MICROORGANISMS MICROBE TERATOGENIC EFFECTS Parvovirus Toxoplasmosis
Zika virus

35. EXPOSURE TO TERATOGENS CONCLUSIONS
Think carefully before prescribing any drug in pregnancy, especially in the first trimester
If you are unsure about the safety of a drug, ask for consultation from your obstetric colleague